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Peds - Spring 2016 > Neurologic Dysfunction (Part 1) - Unit 3 > Flashcards

Neurologic Dysfunction (Part 1) - Unit 3 Flashcards

1
Q

What are some differences between the head in adults and children?

A

Larger heads with weaker neck muscles (top heavy!), thinner cranial bones, less myelinated nerves that are easily injured, open fontanels in infants that can “pop off”

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2
Q

Can little little little kids say they’re nauseous?

A

No

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3
Q

As myelination progresses, what disappears?

A

The primitive reflexes disappear.

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4
Q

Startle reflex - when does it disappear?

A

4-6 months.

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5
Q

When does the palmar grasp disappear?

A

3 months.

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6
Q

When does the plantar grasp disappear?

A

8 months.

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7
Q

When does stepping disappear?

A

2 months

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8
Q

When does tonic neck (fencing - looks like they’re gonna fence) disappear?

A

4-6 months

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9
Q

When does the babinski reflex disappear?

A

2 years

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10
Q

What are parts of the neuro assessment in children?

A

Family history (genetic component), health history (respiratory infection —> meningitis?), physical exam (look at norms, maybe they’re super talkative one day and then not!)

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11
Q

What are parts of the physical exam for neuro?

A

Size and shape of head, level of development, spontaneous activity, postural reflex activity, symmetry of movement (reach with one hand?), tremors, twitching, pupils, vitals, facial features (drooping? stroke?), cry (shrill = head injury), eye movement, lip smacking (seizure!), yawning (involves cranial nerve)

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12
Q

An increase in systolic blood pressure without change in diastolic pressure is referred to as: ???

A

A widened pulse pressure, which is a sign of increased intracranial pressure. Look at pupils!

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13
Q

Consciousness - most important indicator of neurologic dysfunction. T/F?

A

True

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14
Q

Consciousness - the ___ to sensory stimuli.

A

responsiveness.

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15
Q

What are the two aspects of consciousness?

A

Alertness (arousal-waking state with the ability to respond) and cognitive power (ability to process stimuli).

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16
Q

What questions might we ask ask to assess consciousness for pediatrics?

A

“Do you know your parents? What meal is coming next?”

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17
Q

What is confusion?

A

Not oriented X3

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18
Q

What is delirium?

A

Confusion with fear and agitation

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19
Q

What is lethargy?

A

Sluggish speech, very sleepy, increase ICP, post-op, etc.

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20
Q

Obtunded - what is it?

A

Arouses with stimulation.

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21
Q

Stupor - what is it?

A

Slow response to vigorous stimuli, then returns to sleep - grunting happens, too.

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22
Q

Coma - what is it?

A

No response to painful stimuli.

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23
Q

Persistent vegetative state - what is it?

A

Permanent loss of cerebral cortex function, reflexive response - they may track your fingers across the room, it could just be a reflex.

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24
Q

Glasgow coma scale - what 3 parts does it cover? what does a score of 15 mean? 8? 3?

A

Covers eye opening, verbal response, and motor response. 15 = unaltered LOC.
8 or below = usually a coma.
3 = deep coma or death (brain death)

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25
Q

Eye opening - less than one year - what are the numbers?

A

4 - Spontaneous
3 - To shout
2 - to pain
1 - None

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26
Q

Verbal responses - 0 -2 years - what are the numbers?

A 
5 - Babbles, coos appropriately
4 - Cries but is inconsolable
3 - persistent crying or screaming in pain
2 - grunts or moans to pain
1 - None
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27
Q

Motor responses -

A

6 - Spontaneous
5 - Localizes pain
4 - withdraws to pain
3 - Abnormal flexion to pain (decerebrate)
2 - Abnormal extension to pain (decorticate)
1 - None

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28
Q

What are parts of the emergency management of the unconscious child?

A

Airway, reduction of ICP (reduce stimuli, pain, don’t try to wake up), treat shock.

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29
Q

Should parents who are arguing leave the room?

A

Yes

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30
Q

Decerebrate - what is it?

A

Dysfunction of midbrain or lesions of the brainstem - Angel wings (trying to fly to heaven)

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31
Q

Decorticate - what is it?

A

Dysfunction of cerebral cortex or lesions to the corticospinal tracts above the brainstem.

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32
Q

Pain increases ICP - T/F?

A

True

33
Q

With severe neuro issues, what is the primary concern?

A

Airway management!

34
Q

Cerebral hypoxia lasting >4 min may cause irreversible brain damage (cold water can help it last longer, tho) - T/F?

A

True

35
Q

CO2 causes vasodilation, increased cerebral blood flow, and increased ICP - T/F?

A

True

36
Q

Risk of aspiration isn’t there for comatose kids. T/F?

A

NOPE, it is there.

37
Q

Nutrition and hydration - IV administration, caution with over hydration, later begin gastric feedings via NG or GT, patient may continue to have risk for aspiration, etc. T/F?

A

True

38
Q

The pressure that ensures that the brain receives an adequate delivery of oxygen and nutrients is called:

A

Cerebral perfusion pressure.

39
Q

MAP - ICP = ?

A

CPP

40
Q

Normal ICP =

CPP - bare minium =

A

Normal ICP =

41
Q

What are some causes of increased ICP?

A

CSF accumulation (birth trauma, hydrocephalus), increased brain volume, tumors, increased cerebral blood flow

42
Q

What are some signs and symptoms of increased ICP?

A

Full & tense anterior fontanels (watch for ages!), high pitched cry, vomiting (out of nowhere), headache, blurred vision, change in level of consciousness, change in pupil size and decreased response to light, purposeful movement deteriorates, irritability – > lethargy, change in vital signs.

43
Q

What is the Cushing’s reflex?

A

Increase in systolic BP, bradycardia, apnea - portion of brain is displaced due to increased pressure causing damage to brainstem (RR central!)

44
Q

What are the 4 types of ICP monitoring?

A

Intraventricular, subarachnoid bolt, epidural senor, anterior fontanel pressure monitor

45
Q

What are some nursing management things to do for increased ICP?

A

body alignment, decrease stimuli (turn that damn TV down!), respiratory (ventilator), circulatory, GI (BM increases ICP), GU (risk of infection from catheter), early rehabilitation

46
Q

How do we medically manage increased ICP?

A

Cool but not hypothermic conditions, open ventricular drain, osmotic diuretic, sedation/paralysis, appropriate ventilation (Keep PaCo2 a little lower at 25-30)

47
Q

1 cause of death in ages 1-4 = ?

A

Head injuries

48
Q

Traumatic brain injury = blunt or penetrating trauma to the head. T/F?

A

True

49
Q

what are primary head injures?

A

Those injuries that occur at a time of trauma - cause initial cellular damage, included skull fracture, contusions, intracranial hematoma, diffuse injury

50
Q

Swelling - 3 days (most swelling occurs in the 1st 72 hours.) T/F?

A

True

51
Q

Secondary head injures - what are they?

A

Biochemical and cellular response to initial injury, can be immediate or weeks later.

52
Q

Hypoperfusion often occurs within the 1st ___ hours. Brain has ___ metabolic need at this time.

A

24 hours

highest.

53
Q

Secondary head injuries - inflammatory response and release of amino acids. T/F?

A

True

54
Q

What is a concussion?

A

mild TBI - transient and reversible, results form direct trauma to the head and causes alterations in mental status - generally followed by amnesia and confusion.

55
Q

What is pediatric concussion syndrome? Does it cause loss of consciousness?

A

Thought to be related to brainstem injury, seen in young children …. no loss of consciousness at time of injury, BUT may be later (if so, they’ll be clammy, pale, and lethargic)

56
Q

What is post concussion syndrome? Seen in what age?

A

Seen in all ages, causes progressive deterioration - lethargy, disorientation, irritability, behavior changes, pallor, diaphoresis, may lead to headaches persisting beyond 6 weeks.

57
Q

What is second impact syndrome? What can it lead to? How to prevent?

A

Occurs when a second concussion is experienced PRIOR to complete recovery of the first concussion and can lead to cognitive and neurologic deficits and death (related to swelling)…Prevent by making children return to sports ONLY when complete recovery has occurred.

58
Q

What are the two words for “terms used to describe visible bruising and tearing of cerebral tissue?”

A

Contusion and laceration

59
Q

Coup - def

A

bruising at point of impact

60
Q

contrecoup - def

A

bruising at a site far removed from point of impact.

61
Q

Temporal or frontal sections - least commonly injured. T/F?

A

FALSE

62
Q

what are intracranial hematomas?

A

Space occupying lesions - they can develop slowly or rapidly and can be subdural or epidural (worse!)

63
Q

Subdural hemorrhage - fast - T/F?

A

FALSE - slower.

64
Q

Subdural hemorrhage - what is it?

A

Bleeding between the dura and cerebrum and tears in the cortical veins of subdural space. Usually caused by child abuse. :(

65
Q

What are symptoms of subdural hemorrhage?

A

Bradycardia or tachycardia, hypertension, altered LOC, subdural tap or surgical evacuation

66
Q

Epidural hemorrhage - where? what does it do to the brain? How quick? what causes it?

A

Bleeding between the dura and the skull, pushes the brain down and inward - usually due to arterial tears caused from falls - rapid deterioration

67
Q

Skull fractures - only happen to certain cranial bones. T/F?

A

FALSE - can happen to any.

68
Q

Only a little amount of force is required to produce a skull fracture in an infant. T/F?

A

FALSE - a lot of force.

69
Q

Fracture on underside of skull can tear meningeal artery causing severe hemorrhage with hypovolemic hypotension. T/F?

A

True

70
Q

What are the 4 types of skull fractures?

A

Linea, depressed, compound, basilar

71
Q

Linear skull fracture - most common? What kind of impact?

A

It is the most common! Impacts a large area of skull.

72
Q

Depressed skull fracture - break in skull with bone pressing into ___.

A

Brain

73
Q

Compound skull fracture - depressed skull fracture and full thickness scalp laceration. T/F?

A

True

74
Q

Basilar - fracture at the ____ of skull. Which bones?

A

Base - frontal, ethmoid, sphenoid, temporal, or occipital

75
Q

What are the signs of a basilar fracture?

A

Battle’s Sign (swelling/hematoma behind ear), Raccoon Sign (periorbital blood collection), rhinorrhea (CDF leaking into middle ear (halo effect - if some of this drops out, it might leave a bullseye thing)

76
Q

What are some causes of traumatic head injury?

A

Automobile accidents, falls, child abuse

77
Q

How we do manage traumatic brain injury?

A

Care in hospital if severe, LOC, NPO initially, possible surgery

78
Q

What should nurses do for TBI?

A

frequent assessment - VS and neuro, provide analgesia and sedation, careful observation and recording, family support, rehabilitation, prevention, etc.

79
Q

If a patient is unconscious, they have no pain. T/F?

A

FALSE

Peds - Spring 2016 (29 decks)

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